This is the first part of the lecture in Community Health Nursing. This course provides an overview of the Philippine Health Care Delivery System and the different programs implemented by the Philippine Department of Health to promote and protect the health of the people.

1. COMMUNITY HEALTH NURSING
RYAN MICHAEL F. ODUCADO, MAN, MAEd, RN, RM, RPT
Lead Faculty, Community Health Nursing
West Visayas State University
College of Nursing
The DOH &
Selected Public
Health Programs
Philippine Health Care Delivery System, Global and
Country Health Imperatives, The Philippine DOH, Local
Health Systems and Primary Health Care

2. Health Care
Delivery System1

3. Definition of Terms
Health System
– Interrelated system in which a country organizes
available resources for the maintenance and
improvement of the health of its citizens and
communities.
– A health system comprises all organizations,
institutions and resources devoted to producing
actions whose primary intent is to improve health.

4. Health Care System
– An organized plan of health services (Miller- Keane,
1987).
Health Care Delivery
– Rendering health care services to the people
(Williams-Tungpalan, 1981).

5. Health Care Delivery System
– The network of health facilities and personnel which
carries out the task of rendering health care to the
people (Williams- Tungpalan, 1981).
Philippine Health Care System
– It is a complex set of organizations interacting to
provide an array of health services (Dizon, 1977).

6. Philippine Health Care System Context
• Health as a basic human right.
• Department of Health is the lead agency.
• Local Government Code
– The Philippine Government devolved the
management and delivery of health services from the
National Department of Health to locally elected
provincial, city and municipal governments.

7. Philippine Health Care System Context
• Access to health care hampered by:
high cost,
physical and socio-cultural barriers, and
health workforce crisis.

8. 4 Essential Functions of Health System
1. Service provision
2. Resource generation
3. Financing
4. Stewardship

9. Health Care System Models
1. Private Enterprise Health Care Model
2. Social Security Health Model
3. Publicly Funded Health Model
4. Social Health Insurance

10. 1. Private Enterprise Health Care Model
– Purely private enterprise health care systems are
comparatively rare
– Where they exist, it is usually for a comparatively well
–off subpopulation in a poorer country with a poorer
standard of health care.
– E.g. private clinics for a small, wealthy expatriate
population in an otherwise poor country

11. 2. Social Security Health Model
– Where workers and their families are insured by the
state
– Refers to social welfare service concerned with social
protection, or protection against socially recognized
conditions, including poverty, old age, disability,
unemployment and others.

12. 3. Publicly Funded Health Model
– Where the residents of the country are insured by the
state
– Health care that is financed entirely or in majority part
by citizens’ tax payments instead of through private
payments made to insurance companies or directly to
health care providers.

13. 4. Social Health Insurance
– Where the whole population or most of the population is a
member of a sickness insurance company
– SHI is a method for financing health care costs through a
social insurance program based on the collection of funds
contributed by individuals, employers and sometimes
government subsidies.
– Characterized by the presence of sickness funds which
usually receive a proportional contribution of their
members’ wages.
– With this insurance contributions, these funds pay medical
costs of their members
– Affiliation to such funds is usually based on professional,
geographic, religious, political and/or nonpartisan criteria

14. Health Care Utilization
• Physical barriers
– geographical location patterns of health care
consumers in relation to health providers
• Financial factors
– also exists that affect health seeking patterns of the
Filipinos

15. Multisectoral Approach to Health
• The level of health of a community is largely the
result of a combination of factors.
• Health, therefore, cannot work in isolation.
Neither can one sector or discipline claim
monopoly to the solution of community health
problems.
• Health has now become a multisectoral concern.

16. Health System Structure/Composition
PopulationHealth Status
HEALTH SECTOR
HEALTH-RELATED SECTORS
Birth
Death
Morbidity
Mortality
Nutrition
Demographic
Socio-cultural
Political
Economic
Environmental
•Direct provision of health services
•Development and provision of manpower, supplies; financing support
•Research and development
•Coordinating, controlling and directing organizations and activities
L ocal Governments
E ducation
A griculture
P ublic Works
P opulation Control
S ocial Welfare
INTRAsectoral linkages
INTERsectoral linkages

17. Philippine Health Delivery System
It is a complex set of organizations interacting to provide an array of health services.
Public Private
Largely financed through tax-based system Largely market-oriented
National Local Profit Non-profit
DOH
Specialty, retained and
regional hospitals,
medical centers, DOH
representatives
LGU
Provincial and district
hospitals, RHUs, BHSs
Commercial, market
orientation
Private practitioners,
private clinics and
laboratories
Non-commercial,
service orientation
Socio-civic groups,
religious
organizations, or
foundations

18. Global and
Country Health
Imperatives
2

19. Ongoing changes which exert a number
of pressures on the public health system
1. Shift in demographic and epidemiologic
trends in disease
2. New technologies for health care,
communication and information
3. Existing and emerging environmental hazards
with globalization
4. Health Reforms

20. In response, United Nations General Assembly
Common vision:
Poverty Reduction and
Sustainable Development

21. UNITED NATIONS MDGs
Target: Reduce global poverty and hunger
based on the fundamental values of:
• Freedom
• Equality
• Solidarity
• Tolerance
• Health
• Respect for nature
• Shared responsibility

22. UN
Millennium
DevelopmentGoals
1. Eradicate extreme poverty and
hunger
2. Achieve universal primary education
3. Promote gender equality and
empower women
– eliminate gender disparities in
primary/secondary education
4. Reduce child mortality by 2/3 among
children under 5 yrs. old
5. Improve maternal health
– reduce by ¾ the ratio of women dying in
childbirth
6. Combat HIV/AIDs, malaria and other
diseases
7. Ensure environmental sustainability
– reduce to ½ proportion of people without
access to safe drinking water
8. Develop a global partnership

23. Sustainable Development Goals
Countries adopted a set of goals to end poverty,
protect the planet, and ensure prosperity for all
as part of a new sustainable development
agenda.
Each goal has specific targets to be achieved over
the next 15 years.
For the goals to be reached, everyone
needs to do their part.

25. The Philippine
Department of
Health
3

26. Government agency mandated to
PROTECT THE HEATLH OF THE
PEOPLE
Formerly known as:
• Bureau of Health
• Bureau of Health under Bureau of
Public Welfare
• Ministry of Health
• DEPARTMENT HEALTH (EO No.
119 “Reorganizing Ministry of
Health”

27. Primary Function
Promotion, protection, preservation or restoration
of the health of the people through the provision
and delivery of health services and through the
regulation and encouragement of providers of
health goods and services (E.O. No. 119, Sec. 3).

28. A policy and regulatory body for
health.
A technical resource, a catalyzer for
health policy and a political sponsor
and advocate for health issues in
behalf of the health sector.
Provides the direction and national
plans for health programs and
activities

29. With other health providers and stakeholders, the
DOH shall pursue and assure the following:
• Promotion of the health and well-being for every
Filipino;
• Prevention and control of diseases among population
at risk;
• Protection of individuals, families and communities
exposed to health hazards & risks; and
• Treatment, management and rehabilitation of
individuals affected by diseases and disability.

30. Vision by 2030
A global leader for attaining better health outcomes,
competitive and responsive health care system, and
equitable health financing.
Mission
To guarantee equitable, sustainable and quality health
for all Filipinos, especially the poor, and to lead the
quest for excellence in health.

31. CoreValues
Integrity
The Department believes in upholding truth and pursuing honesty,
accountability, and consistency in performing its functions.
Excellence
The DOH continuously strive for the best by fostering innovation,
effectiveness and efficiency, pro-action, dynamism, and openness to
change.
Compassion and Respect for Human Dignity
Whilst DOH upholds the quality of life, respect for human dignity is
encouraged by working with sympathy and benevolence for the
people in need.
Commitment
With all our hearts and minds, the Department commits to achieve its
vision for the health and development of future generations.
Professionalism
The DOH performs its functions in accordance with the highest ethical
standards, principles of accountability, and full responsibility.
Teamwork
The DOH employees work together with a result-oriented mindset.
Stewardship of the Health of the People
Being stewards of health for the people, the Department shall pursue
sustainable development and care for the environment since it
impinges on the health of the Filipinos.

32. Roles and Functions (EO 102)
1. Leadership in Health
2. Enabler and Capacity Builder
3. Administrator of Specific
Services

33. DOH Offices
The DOH is composed of:
17 central offices
16 Centers for Health Development
70 hospitals
4 attached agencies

34. Center for Health Development/DOH
Regional Office
• Responsible for field operations of the Department in its
administrative region and for providing catchment area with
efficient and effective medical services.
• Tasked to implement laws, regulation, policies and programs.
• Tasked to coordinate with regional offices of the other Departments,
offices and agencies as well as with the local governments.
• Act as main catalyst and organizer in the ILHZ formation
• Provide technical support and advocacy for the development of
local health management systems and their integration in the
context of the ILHZ.
• Review and approve ILHZ proposals for funding.
• Integrate local health plans into regional plans.
• Undertake monitoring of the development and implementation of
ILHS.

35. DOH Hospitals
– Provides hospital-based care; specialized or general services,
some conduct research on clinical priorities and training
hospitals for medical specialization.
Attached Agencies
1. The Philippine Health Insurance Corporation is
implementing the national health insurance law,
administers the medicare program for both public and
private sectors.
2. The Dangerous Drugs Board on the other hand,
coordinates and manages the dangerous drugs control
program.
3. Philippine Institute of Traditional and
Alternative Health Care
4. Philippine National AIDS
Council

37. Goal: Health Sector Reformed Agenda
Describes the
major strategies
organizational and policy changes and
public investments
needed to improve the way health care is
delivered, regulated and financed.

38. Rationale for HSRA
• Slowing down in the reduction in the IMR and the MMR.
• Persistence of large variations in health status across the
population groups and geographic areas.
• High burden from infectious diseases.
• Rising burden from chronic and degenerative diseases.
• Unattended emerging health risks from environmental
and work related factors.
• Burden disease is heaviest on the poor.

39. R
e
a
s
o
n
s
1. Inappropriate health delivery
system as shown by an
inefficient and poorly targeted hospital system
ineffective mechanism for providing public health
programs on top of health human resources
maldistribution.
2. Inadequate regulatory mechanisms
for health services resulting to:
poor quality health care
high cost of privately provided health services
high cost of drugs and
presence of low quality of drugs in the market
3. Poor health care financing and
inefficient sourcing or generation of
funds for health care.

40. FOURmula One for Health
Framework for HRSA
Intends to implement critical interventions as a
single package.
Directed to ensuring
• ACCESSIBLE
• AFFORDABLE
• QUALITY health care especially for the more disadvantage
and vulnerable sectors of the population.

41. Goals of HSRA
1. Better health
outcomes
2. More responsive
health systems
3. Equitable health care
financing

42. 1. Health Financing
2. Health Regulation
3. Health Service Delivery
4. Good Governance
Elements of HSRA

43. 1. Health Financing
 Goal: To foster greater, better and sustained health
investments in health
 Key feature: Philippine Health Insurance Corporation
through the NATIONAL HEALTH INSURANCE
PROGRAM
– Expand enrolment
– Improve benefits
– Leverage payments for quality of care

44. 2. Health regulation
 Goal: To ensure the quality and affordability of
health goods and services
 Components for Implementation: Quality seals
for products and services (enhancing Pharma or
GMA 50)- expanded
3. Health service delivery
 Goal: To improve and ensure the accessibility and
availability of basic and essential health care in both
public and private facilities and services
 Components for Implementation: Quality seals for
health provider

45. 4. Good governance
 Goal: To enhance health system performance at
the national and local levels
 Components for Implementation:
• Implement HSRA & FOURmula One as a single
package
• Develop LGU score card
• Local & management support (ILHZ, LHB, Councils)

46. • Sets target and the critical
indicators, current strategies based
on field experiences and laying
down new avenues for improved
interventions.
National Objectives for Health (NOH)
2005 to 2010

47. 1. Improve the general health status if the
population
2. Reduce morbidity and mortality of certain
diseases
3. Eliminate certain diseases as public health
problems
4. Promote healthy lifestyle and environmental
health
5. Protect vulnerable groups with special
health and nutrition needs
6. Strengthen national and local health systems
to ensure better health service delivery
Objectives of the Health Sector

48. 7. Pursue public health and hospital reforms
8. Reduce the cost and ensure the quality of
essential drugs
9. Institute health regulatory reforms to ensure
quality and safety of health goods and services
10.Strengthen health governance and management
support systems
11.Institute safety nets for the vulnerable and
marginalized groups
12.Expand the coverage of social health insurance
13.Improve efficiency in the allocation, production
and utilization of resources for health

49. • Is a long-term directional plan/blueprint for
health covering the period of 1995-2020
• Formulation coordinated and facilitated by:
– National Health Planning Program
• A special project lunch by the DOH in line with the
government’s thrust for PEOPLE EMPOWERMENT
• County plan originated from multisectoral effort
involving various disciplines and sectors
• Indicates general directions and broad strategies
for an EFFICIENT AND EFFECTIVE HEALTH CARE
DELIVERY in the country.
National Health Plan

50. • Health is a basic human right.
• Health is both a means and an end of
development.
– Health is an integral part of development. It is
affected by and in turn affects other components of
socoi-economic system.
– Healthy population is a prerequisite to achieve
development.
Guiding Principles

51. • A SOCIALLY and ECONOMICALLY productive
population with longer life expectancy, low
infant and maternal mortality, less disability, with
adequate shelter, education and means of
livelihood.
NP Vision

52. Current Goals, Objectives, Strategic
Thrusts & Strategies
To successfully implement the Aquino Health
Agenda (AHA), the Philippine health system will
require the following components:
• enlightened leadership and good governance practices;
• accurate and timely information and feedback on performance;
• financing that lessens the impact of expenditures especially
among the poorest and the marginalized sector; competent
workforce;
• accessible and effective medical products and
technologies; and
• appropriately delivered essential services.

53. Overall Goal
The implementation of Universal Health Care shall
be directed towards ensuring the achievement of
the health system goals of
• Better health outcomes;
• Sustained health financing; and
• Responsive health system
by ensuring that all Filipinos, especially the
disadvantaged group in the spirit of solidarity,
have equitable access to affordable health care.

54. General Objective
Universal Health Care is an approach that seeks
to improve, streamline, and scale up the reform
strategies in Health Sector Reform Agenda
(HSRA) and Fourmula 1 (F1) for Health in order
to address inequities in health outcomes by
ensuring that all Filipinos, especially those
belonging to the lowest two income quintiles,
have equitable access to quality health care.

55. Aquino Health Agenda (AHA) and
National Objectives For Health 2011-2016
• Is a focused approach to health reform implementation in the
context of HSRA and F1, ensuring that all Filipinos especially the
poor receive the benefits of health reform.

56. Universal Health Care
• Also referred to as Kalusugan Pangkalahatan
(KP)
• It is the provision to every Filipino of the highest
possible quality of health care that is accessible,
efficient, equitably distributed, adequately
funded, fairly financed, and appropriately used
by an informed and empowered public.

57. Three Strategic Thrusts of UHC
1.Financial Risk Protection
2.Improved Access to Quality Hospitals
and Health Care Facilities
3.Attainment of the Health-related
MDGs

58. NHIP
CHT HFEP

59. Local
Health System4

60. Devolution
Refers to the act by which the National
Government confers power and authority upon
the various local government units to perform
specific functions and responsibilities, including
the provision and delivery of health care services
Devolution made local government executives
responsible to operate local health services.

61. Objectives of the Local Health System
• Establish local health systems for effective and efficient
delivery of health care services.
• Upgrade the health care management and service
capabilities of local health facilities.
• Promote inter-LGU linkages and cost sharing schemes
including local health care financing systems for better
utilization of local health resources.
• Foster participation of the private sector, non-
government organizations (NGOs), and communities in
local health systems development.
• Ensure the quality of health service delivery at the local
level.

62. Local Health Boards
Each local government unit has a local health
board which proposes annual budgetary
allocations for the operations of health services
within the locality.

63. Provincial Health Board
Organizational Structure
Governor
Provincial
Health Office
Provincial
Health Board
Provincial
Hospitals
District
Hospitals
Other
Health and
Medical
Facilities
Chairman: Governor
Vice Chair: Provincial Health Officer
Members:
•Chairman on the Committee on
Health of the Sangguniang
Panlalawigan
•DOH Representative
•NGO Representative

64. Mayor
Municipal
Health Office
Municipal
Health Board
RHU BHS
Chairman: Mayor
Vice Chair: Municipal Health Officer
Members:
•Chairman on the Committee of
Health of the Sangguniang
Panglungsod
•DOH Representative
•NGO Representative
Municipal Health Board
Organizational Structure

65. Restructured Health Care Delivery System
• Adopted primary health care approach that
integrates at the community level all elements
necessary to make impact upon the health status of
the people.
• Is in effect the combination of main
health center and satellite barrio health
stations which is essentially the basis for
the implementation of the new system.

66. Objectives of RHCDS
• To strengthen the rural health services and
to effect a more efficient and effective
delivery care of health services in the
country

67. Main Health Center
– Location:
municipality
– Own catchments
area: 5,000
population more or
less
– Staff: complete
team
Barrio Health Stations
– Located in a strategic
area beyond 3-5
kilometer from MHC
– Catchments area: 5,000
population
– Staffed by RHM

68. Inter Local Health System
• It is a system of health care similar to district health
system in which individuals, communities and all other
health care providers in a well-defined geographical area
participate together in providing quality, equitable and
accessible health care with Inter Local Government Unit
(ILGU) partnership as the basic framework.
• Overall concept is the creation of an Inter
Local Health System by clustering
municipalities into Inter Local Health Zone
(ILHZ).

69. Inter Local Health Zone (ILHZ)
Unit of the health system created for local health service
management and delivery in the Philippines.
Has a defined population within a defined geographical
area and comprises a central or core referral hospital
and a number of primary level facilities such as RHUs
and BHS.
Includes all stakeholders involved in the delivery of health
services

70. Importance of establishing an ILHZ
1. To re-integrate hospital and public health services
for a holistic delivery of health services
2. To identify areas of complementation of the
stakeholders – LGUs at all levels, DOH, PHIC,
communities, NGOs, private sector and others.

71. Composition of ILHZ
1. People
• The number of people may vary from zone to zone
• Community members, NGOs, people’s organizations, local
chief executives, other gov’t officials, private sector
• WHO ideal health district would have a population size
between 100,000 to 500, 000 for optimum efficiency and
effectiveness
2. Boundaries
• Clear boundaries between ILHZ determine the
accountability and responsibility of health care services
providers, geographical locations and access to referral
facilities
3. Health facilities
4. Health workers

72. Core Referral Hospital
– Main hospital for ILHZ and its catchment population
– Main point of referral for hospital services from the
community, private medical practitioner and public
health services at BHS and RHUs
– Minimum services
• Out-patient services
• Lab and radiological diagnostic services
• Inpatient care
• Surgical services sufficient to provide emergency care for
basic life threatening conditions, obstetrics and trauma

73. District Health System
– A contained segment of the national health system
which comprises a well-defined administrative and
geographic area either rural or urban and all
institutions and sectors whose activities contribute to
improve health (WHO).
Two-Way Referral System
– A two-way referral system need to be established
between each level of health.

74. •Devolved in cities and municipalities
•Provided by center physicians, RHNs,
RHMs, BHWs, traditional healers
•First contact between the community
members and other levels of health
facility
•Given by physicians with basic health
training
•Serves a referral center of primary
health care facilities
•Capable of performing minor
surgeries and perform simple
laboratory examinations
•Rendered by specialist
•Referral center of secondary care
facilities

75. New Classification Scheme of Health
Facilities (DOH, 2012)
Classification of Health Facilities
Hospitals Other Health Facilities
General
Level 1
Level 2
Level 3
Specialty 1. Primary Care Facility
Without in-patient beds like health centers, out-patients clinics and
dental clinics
With in-patient beds – short stay facility where the patient spends 1 to
2 days before discharge like infirmaries and birthing facilities
2. Custodial Care Facility
custodial psychiatric facilities, substance/drug abuse treatment and
rehabilitation centers, sanitaria/leprosaria, and nursing homes
3. Diagnostic Facility
laboratory, radiologic and nuclear medicine facility
4. Specialized Outpatient Facility
dialysis clinic, cancer chemotherapy clinic, cancer radiation facility,
physical medicine and rehabilitation center/clinic

76. Primary
Health Care5

77. Definition
• The essential health care based on practical, scientifically sound
and socially acceptable methods and technology made universally
accessible to individuals and families in the community through
their full participation and at a cost that the community and
country can afford to maintain at every stage of their development
in the spirit of SELF-RELIANCE and self- determination (Alma, Ata).
• An approach to health development which is
carried through a set of activities and whose
ultimate aim is continuous improvement and
maintenance of the health status of the
community (DOH).

78. Definition
• The collective impact of the community health nurses in PHC
concept embraces the provision of basic essential services –
promotive, preventive, curative and rehabilitative – for the total
population at the local community level (Thompson).
• As an approach, requires the community health
nurse to be competent in a number of
responsibilities including promoting self-reliance in
health care among individuals and families,
collaborating with development sectors in promoting
health and preventing diseases and disability and
extending health care coverage to all segments of
the population especially vulnerable groups
(Rodolfo).

79. Available
Accessible
Affordable
Acceptable
Attainable

80. Rationale
a. Magnitude of health problems
b. Inadequate and unequal distribution of health
resources
c. Increasing cost of medical care
d. Isolation of health care activities from other
development

81. Objectives
a. To develop and maximize people potential and
self-reliance of the community for the
improvement of their own health.
b. To maximize the contributions of other sectors
of health.
c. To maximize the extension of effective health
care services to the periphery.

82. Objectives
Others
– Improvement in the level of health care of the community.
– Favorable population growth structure.
– Reduction in the prevalence of preventable, communicable
and other disease.
– Reduction in morbidity and mortality rates especially
among infants and children.
– Extension of essential health services with priority given to
the underserved sectors.
– Improvement in basic sanitation.
– Development of the capability of the community aimed at
self- reliance.
– Maximizing the contribution of the other sectors for the
social and economic development of the community.

83. Mission: To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will manage their
own health care.
Goal: Health for All by the Year 2000
Theme: Health for All and Health in the Hands of
the People by the Year 2020
Key Strategy to Achieve Goal: Partnership with
empowerment of the People

84. The strategy for achieving health for all is based on
four basic points
a. Use of technology that is scientifically and socially
acceptable as well as economically sound.
b. Political efforts to improve health, thus improving
people’s economic and social status.
c. Cooperation of the health sector with other sectors
such as education, agriculture, industry and media.
d. Community and individual participation.

85. Basic Concepts
a. Health is related to social structures. Health
problems are brought about by economic, political
and cultural problems and vice-versa.
b. Health and development are interrelated.
c. People’s participation is essential.
d. Community organizing is the core in PHC.
e. Use of appropriate technology. Making use of
available resources is a step to self-reliance and
making the community aware of its potential and
resources bring about self-appreciation.

86. • Principles
a. People as the Center of Development
b. Center of Equity – Depressed, deprived and underserved
(DDU) individuals, families and communities are high in
the agenda of the Department of Health
c. Respect for area-based knowledge and capacities
d. Social accountability to the Community
e. Devolution as an opportunity for Empowerment
f. Balancing Promotive/Preventive Care and
Curative/Rehabilitative Care
g. Continuing concern for strengthening the capacity for
PHC
h. Paradigm shift as a requirement of PHC

87. E ducation for Health
L ocal Endemic Disease Prevention & Control
E xpanded Program on Immunization
Maternal and Child Health/Family Planning
E ssential Drugs Provision/Herbal Medicines
N utrition
T reatment of Communicable Diseases & Accidents
S afe Water and Sanitation
Components

88. Pillars
1. Use of appropriate technology
– This implies the use of methods, procedures,
techniques, equipment or materials that are not
only scientifically sound, but also provides a
socially and environmentally acceptable service
or product at the least economic cost.
2. Multisectoral approach
a. Intersectoral linkages
b. Intrasectoral linkages
3. Active community participation
4. Support mechanisms made
available
Criteria
a.Effectiveness and Safety –
produces the desired effect
without harm.
b.Complexity – simple and
easy to apply by the health
care providers and clientele.
c.Cost – affordable for all
people.
d.Scope of technology –
directly related to
effectiveness, safety,
appropriateness and
affordability.
e.Acceptability –
understandable and attuning
with the cultural practices of
the people.
f.Feasibility – compatible
with the local condition of the
community.

89. Strategies
a. Reorientation and reorganization of the national health
care system
b. Effective preparation and enabling process for health
action
c. Mobilization of the people to know their communities
and identifying their basic health needs
d. Development and utilization of appropriate technology
e. Organization of communities arising from their
expressed needs
f. Increase opportunities for community participation
g. Development of inter-sectoral linkages with other
government and private agencies
h. Emphasizing partnership

90. • Other major strategies:
– Elevating health to a comprehensive and sustained
national effort
– Promoting and supporting community managed
health care
– Increasing efficiency in health sector
– Advancing essential national health research

91. Social Mobilization
– It is a broad-scale movement to engage people’s
participation in achieving a specific development or
health goal through self-reliant efforts — those that
depend on their own resources and strengths (UNICEF).
– It involves all relevant segments of society:
policymakers and other decision-makers, opinion
leaders, the media, bureaucrats and technical experts,
professional associations, religious groups, the private
sector, NGOs, community members, and individuals.
– It is a planned decentralized process that seeks to
facilitate change through a range of players engaged
in interrelated and complementary efforts.

92. – It takes into account the felt needs of the people,
embraces the critical principle of community
involvement, and seeks to empower individuals and
groups for action.
Can be done by:
• Establishment of an effective health referral system.
• Multi-sectoral and interdisciplinary linkages
• Information, education and communication support
through multimedia.
• Collaboration between government and non-
government organization.

93. Dimension Traditional PHC
Goal Absence of disease Development and preventive health
care
Focus of Care Sick Well and sick
Setting Urban-based hospitals, clinic,
homes
Rural-based satellite clinics
Health of Posts Accessible only to a few Accessible to all community health
center
People Passive recipients and health
care
Active participation in health and
development
Structure Health isolated from other
sectors
Health is an integral part of socio-
economic development
Process Top-Down Bottom-top decision making
Technology Curative services based on
modern technology
Promotive and preventive services
blending traditional and modern
medicine
Jurisdiction Doctor dominated Acceptance of indigenous
practitioner; Appropriate
technology for frontline care
Outcome Reliance on health
practitioner
Self-reliance, socially and
economically productive

94. Types of Primary Health Care Workers
Vary according to:
a. Available health manpower
b. Local health needs and problem
c. Political and financial stability
1. Village Health Workers
2. Intermediate Level Health Workers
3. Health Personnel of First-Line Hospitals

95. Type Characteristics Examples
Village Health
Workers
•Initial link, 1st contact of community
•Works in liaison w/ the local health
services workers
•Provides elementary curative and
preventive health care measures
Trained Community Health
worker
Auxillary health volunteer
Traditional birth attendant
Healers
Intermediate
Level
•1st source of professional health care
•Attends to health problems beyond the
competence of village health workers
•Provides support to the frontline health
workers in terms of supervision, training,
referral services and supplies thru linkages
with other sectors
General Health Practitioners
Public Health Nurses
Midwives
RSI
Health
Personnel of
First-Line
Hospitals
•Establishes close contact with the village
and intermediate level health workers to
promote the continuity of care from
hospital to community to home
•Provides back-up health services for
cases requiring hospitals or diagnostic
facilities not available in health care
Physicians with Specialization
Nurses
Dentists